Page 1 of 163
“ PN NCLEX POSTPARTUM “LATEST 2025
UPDATED EXAM 2025 – 2026 SOLVED
QUESTIONS & ANSWERS VERIFIED 100%
GRADED A+ (LATEST VERSION)
PN NCLEX POSTPARTUM
A nurse is monitoring a client at risk for postpartum endometritis. Which
observation noted during the first 24 hours after delivery may support this
diagnosis?
Abdominal tenderness and chills
(Symptoms in the postpartum period heralding endometritis include delayed uterine
involution, foul-smelling lochia, tachycardia, abdominal tenderness, and temperature
elevations up to 104° F. This intrauterine infection may lead to further maternal
complications such as infections of the fallopian tubes, ovaries, and blood (sepsis).
Options 1, 2, and 4 represent normal maternal physiological responses in the
immediate postpartum period. These changes represent the normal adaptation of
reproductive organs (involution) and maternal physiological responses because of
the decreased hormonal levels and fluid losses that occur during labor.)
As a part of discharge teaching, a new mother has been provided with
instructions about how to perform postpartum exercises. The nurse
determines that the client understands the instructions when she states that:
, Page 2 of 163
She should alternately contract and relax the muscles of the perineal area.
(Kegel exercises are extremely important to strengthen the muscle tone of the
perineal area. Postpartum exercises can begin soon after birth. The initial exercises
should be simple, with progression to increasingly strenuous exercises. Women who
maintain the perineal muscle tone may benefit in later life by the development of less
stress urinary incontinence.)
A nurse receives a report at the beginning of the shift regarding a client with
an intrauterine fetal demise. Which of the following would the nurse expect to
note when collecting data on the client?
Regression of pregnancy symptoms and absence of fetal heart tones
(Symptoms of an intrauterine fetal demise include decrease in fetal movement, no
change or a decrease in fundal height, and absent fetal heart tones. Many symptoms
of pregnancy may diminish, such as uterine size, and breast size and tenderness.
Option 2 identifies signs of preeclampsia. Option 3 can be a result of twins. Option 4
is associated with hyperemesis gravidarum.)
A nurse is adding to a plan of care for a postpartum client. Which intervention
will promote parent-infant bonding?
Encourage her to hold the infant even when the infant is crying.
(Holding the infant close and allowing the infant to feel the warmth initiates a positive
experience for the mother and consoles the infant. The use of a high-pitched voice
and participating in infant care are additional methods of promoting parent-infant
attachment. Infants should not be allowed to sleep in the parental bed. The parents
require time alone as a couple. Additionally, the danger of suffocation of the infant
exists if the infant is allowed to sleep between the parents.)
A postpartum nurse is about to reinforce discharge instructions to a
postpartum client who delivered a healthy newborn infant. The occurrence of
which event should be reported to the health care provider?
, Page 3 of 163
Pain, redness, or swelling in the breasts
(Signs of infection include pain, redness, heat, and swelling of a localized area of the
breast. If these symptoms occur, the client needs to contact the health care provider.
Options 1, 3, and 4 are normal changes that occur in the postpartum period.)
A client arrives to the postpartum unit following the delivery of her newborn
premature infant. On data collection, the nurse notes that the client is shaking
uncontrollably. Which of the following nursing actions is appropriate?
Covering her with a warm blanket
(In the postpartum period, a woman may commonly experience a shaking and
uncontrollable chill immediately after birth. The exact cause of this occurrence is not
known; however, it is thought to be associated with a nervous system reaction such
as a vasovagal response. If the chill is not associated with an elevated temperature,
it is of no clinical significance. The best nursing action is to provide a warm blanket to
the client and a warm drink if this is not contraindicated. It is not necessary to contact
the health care provider. Massaging the fundus and placing the client in the
Trendelenburg's position have no effect on the client's condition.)
A nurse is collecting data on a postpartum client and performs which best
intervention when checking for thrombophlebitis in the legs?
Checks the calf areas for redness or swelling
(Redness, swelling, and pain in the calf area are signs of thrombophlebitis, a
potential complication in the postpartum period. Options 1 and 4 do not determine
the presence of thrombophlebitis. Although the client with thrombophlebitis may
experience pain when ambulating, option 3 is not the best intervention from those
provided in the options.)
A postpartum nurse reinforces information provided to a new mother following
a vaginal delivery regarding a sitz bath. The nurse determines that the client
understands the purpose of the sitz bath when the client states that it will:
, Page 4 of 163
Promote healing of the perineum.
(Warm, moist heat provided by a sitz bath is used 24 hours after tissue trauma from
a vaginal birth to provide comfort and promote healing and reduce the incidence of
infection. Ice is used in the first 24 hours to reduce edema and numb the tissue in
the perineal area. Promoting a bowel movement is best achieved by ambulation.
Thrombophlebitis prevention is not related to a sitz bath.)
A nurse attempts to encourage a new mother to understand and to accept the
cesarean section that was necessary to deliver her baby, rather than to focus
on the surgical aspect of the procedure. Which nursing statement would
provide the best encouragement?
"Tell me about the delivery of your baby."
(It is important for the mother to think of the procedure as the birth of the baby. The
mother may become disappointed because she was unable to deliver vaginally,
complicating the postpartum phase. Option 2 brings the surgery to focus and can
inhibit the mother from bonding with the neonate. Options 3 and 4 place the focus on
the future, and the mother needs to focus on the birth of the baby.)
Oxytocin (Pitocin) is prescribed to be administered intravenously to a client
after a cesarean delivery. The nurse understands that the action of the
medication is to:
Stimulate the uterus to contract, thus reducing possible blood loss.
(The action of oxytocin is to stimulate the uterus to contract, to control uterine atony,
and therefore reduce hemorrhage. Options 2, 3, and 4 are not actions of this
medication.)
A nurse is caring for a client with placenta previa who is at high risk for
infection and hemorrhage, as a result of this condition. The nurse plans care
based on what information related to the condition?
Fewer muscle fibers in the lower segment of the uterus will result in poor
contractions.
“ PN NCLEX POSTPARTUM “LATEST 2025
UPDATED EXAM 2025 – 2026 SOLVED
QUESTIONS & ANSWERS VERIFIED 100%
GRADED A+ (LATEST VERSION)
PN NCLEX POSTPARTUM
A nurse is monitoring a client at risk for postpartum endometritis. Which
observation noted during the first 24 hours after delivery may support this
diagnosis?
Abdominal tenderness and chills
(Symptoms in the postpartum period heralding endometritis include delayed uterine
involution, foul-smelling lochia, tachycardia, abdominal tenderness, and temperature
elevations up to 104° F. This intrauterine infection may lead to further maternal
complications such as infections of the fallopian tubes, ovaries, and blood (sepsis).
Options 1, 2, and 4 represent normal maternal physiological responses in the
immediate postpartum period. These changes represent the normal adaptation of
reproductive organs (involution) and maternal physiological responses because of
the decreased hormonal levels and fluid losses that occur during labor.)
As a part of discharge teaching, a new mother has been provided with
instructions about how to perform postpartum exercises. The nurse
determines that the client understands the instructions when she states that:
, Page 2 of 163
She should alternately contract and relax the muscles of the perineal area.
(Kegel exercises are extremely important to strengthen the muscle tone of the
perineal area. Postpartum exercises can begin soon after birth. The initial exercises
should be simple, with progression to increasingly strenuous exercises. Women who
maintain the perineal muscle tone may benefit in later life by the development of less
stress urinary incontinence.)
A nurse receives a report at the beginning of the shift regarding a client with
an intrauterine fetal demise. Which of the following would the nurse expect to
note when collecting data on the client?
Regression of pregnancy symptoms and absence of fetal heart tones
(Symptoms of an intrauterine fetal demise include decrease in fetal movement, no
change or a decrease in fundal height, and absent fetal heart tones. Many symptoms
of pregnancy may diminish, such as uterine size, and breast size and tenderness.
Option 2 identifies signs of preeclampsia. Option 3 can be a result of twins. Option 4
is associated with hyperemesis gravidarum.)
A nurse is adding to a plan of care for a postpartum client. Which intervention
will promote parent-infant bonding?
Encourage her to hold the infant even when the infant is crying.
(Holding the infant close and allowing the infant to feel the warmth initiates a positive
experience for the mother and consoles the infant. The use of a high-pitched voice
and participating in infant care are additional methods of promoting parent-infant
attachment. Infants should not be allowed to sleep in the parental bed. The parents
require time alone as a couple. Additionally, the danger of suffocation of the infant
exists if the infant is allowed to sleep between the parents.)
A postpartum nurse is about to reinforce discharge instructions to a
postpartum client who delivered a healthy newborn infant. The occurrence of
which event should be reported to the health care provider?
, Page 3 of 163
Pain, redness, or swelling in the breasts
(Signs of infection include pain, redness, heat, and swelling of a localized area of the
breast. If these symptoms occur, the client needs to contact the health care provider.
Options 1, 3, and 4 are normal changes that occur in the postpartum period.)
A client arrives to the postpartum unit following the delivery of her newborn
premature infant. On data collection, the nurse notes that the client is shaking
uncontrollably. Which of the following nursing actions is appropriate?
Covering her with a warm blanket
(In the postpartum period, a woman may commonly experience a shaking and
uncontrollable chill immediately after birth. The exact cause of this occurrence is not
known; however, it is thought to be associated with a nervous system reaction such
as a vasovagal response. If the chill is not associated with an elevated temperature,
it is of no clinical significance. The best nursing action is to provide a warm blanket to
the client and a warm drink if this is not contraindicated. It is not necessary to contact
the health care provider. Massaging the fundus and placing the client in the
Trendelenburg's position have no effect on the client's condition.)
A nurse is collecting data on a postpartum client and performs which best
intervention when checking for thrombophlebitis in the legs?
Checks the calf areas for redness or swelling
(Redness, swelling, and pain in the calf area are signs of thrombophlebitis, a
potential complication in the postpartum period. Options 1 and 4 do not determine
the presence of thrombophlebitis. Although the client with thrombophlebitis may
experience pain when ambulating, option 3 is not the best intervention from those
provided in the options.)
A postpartum nurse reinforces information provided to a new mother following
a vaginal delivery regarding a sitz bath. The nurse determines that the client
understands the purpose of the sitz bath when the client states that it will:
, Page 4 of 163
Promote healing of the perineum.
(Warm, moist heat provided by a sitz bath is used 24 hours after tissue trauma from
a vaginal birth to provide comfort and promote healing and reduce the incidence of
infection. Ice is used in the first 24 hours to reduce edema and numb the tissue in
the perineal area. Promoting a bowel movement is best achieved by ambulation.
Thrombophlebitis prevention is not related to a sitz bath.)
A nurse attempts to encourage a new mother to understand and to accept the
cesarean section that was necessary to deliver her baby, rather than to focus
on the surgical aspect of the procedure. Which nursing statement would
provide the best encouragement?
"Tell me about the delivery of your baby."
(It is important for the mother to think of the procedure as the birth of the baby. The
mother may become disappointed because she was unable to deliver vaginally,
complicating the postpartum phase. Option 2 brings the surgery to focus and can
inhibit the mother from bonding with the neonate. Options 3 and 4 place the focus on
the future, and the mother needs to focus on the birth of the baby.)
Oxytocin (Pitocin) is prescribed to be administered intravenously to a client
after a cesarean delivery. The nurse understands that the action of the
medication is to:
Stimulate the uterus to contract, thus reducing possible blood loss.
(The action of oxytocin is to stimulate the uterus to contract, to control uterine atony,
and therefore reduce hemorrhage. Options 2, 3, and 4 are not actions of this
medication.)
A nurse is caring for a client with placenta previa who is at high risk for
infection and hemorrhage, as a result of this condition. The nurse plans care
based on what information related to the condition?
Fewer muscle fibers in the lower segment of the uterus will result in poor
contractions.
